Privatising the NHS: dentistry paves the way

Mixed purchasing must be managed

The suggestion last year that mixed public and private finance might be introduced to health care in Britain1 provoked an outcry among supporters of the NHS.2 Many feared that the government would extend free market principles and accelerate privatisation because of worries about NHS funding. However, the mixed purchasing proposals had a historical ring to most dentists. NHS dentistry has already forged close links with the private sector. Strict curbs on NHS spending on dentistry have led to patients' co-payments increasing steadily and to a rapid expansion of the private market. Although the number of dentists in the general dental service of the NHS rose from under 15000 in 1979 to 19400 in March 1994,3 the number who are also registered with the three largest private dental insurance schemes has risen from none to about 7500 in the past 10 years. These changes provide salutary lessons for other areas of health care.

Despite the growing contribution of the private sector, the demands on public funds continue to increase. Between 1978-9 and 1993-4, gross expenditure on general dental services in Britain increased by 57% in real terms to pounds sterling1475m. Net expenditure (excluding patients' contributions) increased by 37% over the same period.3 Costs to the Treasury of emergency dental care have risen particularly quickly, from pounds sterling2.7m in 1989 to pounds sterling10.7m in 1993.4 At 31 March 1994, 25.4 million people were …